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1991-07-25 Regular Meeting/03 -OF -0 i ("; KODIAK ISLAND HOSPITAL ADVISORY BOARD MEETING JULY 25, 1991 PRESENT: Ben Ardinger, William Brewer, Betty Springhill, Wayne Stevens, Lorne White, Ed Myers, Administrator, Keith Vorachek, Finance Manager, Kate Fitzgerald, Patient Care Administrator, Corlene Hogg, Director of Ancillary & Patient Information Services, Drs. Kevin Creelman, Lynn Mickleson, Loren Halter, Joe Smith, LHS Management Compa- ny Gil Bane, Gordon Gould, Gretchen Saupe, Jeannie Volker With a quorum present, the meeting was called to order at 7:05 P.M. ACCEPTANCE OF AGENDA: Moved, seconded and carried to accept the agenda. APPEARANCES AND COMMUNICATIONS Joe Smith reported that he and Wayne Stevens had met with the Board of Directors of the medical clinic in Dutch Harbor and that they had dis- cussed ways to stabilize the clinic and physician services and possi- bilities of interaction with Kodiak Island Hospital & Care Center. Mr. Smith briefly outlined possible use of KIH personnel and services in the areas of outpatient surgery, sharing of supplies, and teleradiology. The possibility of our ER physicians serving as supervisors for Physi- cian Assistants at the clinic was touched on, Mr. Smith noting that this could generate revenue for KIH/CC. It was noted that the community of Dutch Harbor is similar to that of Kodiak -- an island community, fish- ing economy, and that they share common problems. Mr. Smith stated that Dutch Harbor's facility is small and that the community is seeking $3.5 million to build a new clinic. He stated that he felt it might be feasible to recruit a second surgeon to help cover the needs of Dutch Harbor, if the transportation issues could be resolved. There was a discussion regarding the financial statement and treatment statistics of the Dutch Harbor facility. Another benefit for Dutch Harbor being associated with KIH would be the possibility of group purchasing. Mr. Stevens noted that he has been talking with the air transportation industry regarding increased services between Dutch Harbor and Kodiak, which would be important in providing medical services. Advisory Board Meeting July 25, 1991 Page Two Dr. Brewer asked about other small communities joining to form a consor- tium. Mr. Stevens stated that the Southwest Alaska Municipal Conference is being held in Kodiak in September and that he felt it would be an excellent time for staff and board members to meet with other community leaders. Dr. Creelman noted that he had sponsored P.A.'s in Cold Bay and Sand Point several years ago, and that those communities might also be interested in the types of services being discussed. MEETING MINUTES JUr�e 2(,, Moved, seconded and carried to approve the meeting minutes of July--2Sr_ 1991 as distributed. COMMITTEE REPORTS Keith Vorachek reported that the May financial analysis of the facility disclosed a $48,000 overall increase. Contributing factors included a higher occupancy rate and increased surgeries. He reported that June was also a strong financial month, with an overall gain of $33,000. He reported that expenses showed an increase due to the increase in activi- ty. He reported that a refund from MICA had been deposited into the self-insurance trust. OLD BUSINESS A. Rnergency Room Deferred until later in the meeting. B. Credit Collection Policy Mr. Myers reviewed some of the areas which have historically presented problems in collection. 1. The island has a large transient population, many of whom use the Emergency Room. Most are uninsured and it is very difficult to recover payment from them. 2. The public is very reluctant to make any payment on medical services "up -front". Mr. Myers stated that an effort is underway to establish a policy which will be specific as to payment alterna- tives. 3. There are ten patient accounts totalling nearly $500,000 which increases the A/R days. Mr. Myers stated that the financial de- partment is working to identify and segment those accounts, and is working with local banks to establish recourse notes. Advisory Board Meeting July 25, 1991 Page Three 4. The hospital employs three billers/collectors. With Accounts Receivable running at approximately $2.2 million, the hospital's clerks have reached the saturation point, beyond which they lose effectiveness. There are over 1,000 collectable accounts and it is a very time consuming process to collect. Mr. Myers stated that he would like to get the Accounts Receivables into the 70-80 day range. 5. Turnover in the Business office has been high, with seventeen personnel leaving in the last three years. 6. Under the OBRA regulations, manually submitted Medicare bills can be held for 30 to 60 days before being reviewed for payment. The facility cannot bill supplemental carriers until Medicare approves the bill, further extending the A/R days. Ms. Springhill asked how what percentage of patients were on Medicare. Mr. Myers stated that approximately 17% of our patient days were bill- able to Medicare. Ms. Springhill asked if someone could be- specifically trained in Medicare reimbursement. NEW BUSINESS A. Community Survey Results Mr. Myers stated that tabulations of the survey have been completed and will be presented at a later meeting. B. Home Health Mr. Myers reported that there have been discussions with Joan Minks regarding possibilities of the facility becoming involved with Home Health. Recommendations regarding this issue will be presented at a later meeting. OLD BUSINESS (continued) A. Emergency Room Mr. Myers reported that he had presented a number of alternative staffing proposals to the Medical Staff and after a great deal of discussion, had offered the Medical Staff two alternatives for covering the Emergency Room. Mr. Myers noted that the Emergency Room had run at a $42,000 defi- cit for the first six months of this year, and that only during the last two months had there been an increase in revenues due to higher traffic and revised charges. Advisory Board Meeting July 25, 1991 Page Four Dr. Creelman stated that he felt that the proposal as presented was too high a cost to the facility and proposed that the term of the contract be reduced from one year to three months. There was much discussion regarding the proposed contract. Mr. Myers noted that the savings under the contract will come from the reduction in locum tenens usage for coverage. Dr. Halter asked if physicians working E.R. rotation would be covered under the facility's self insurance trust. Mr. Myers stated that it would. Responding to a suggestion that E.R. patients be seen in the physi- cian's office when that physician has E.R. duty, Mr. Myers stated that the courts have stated that the hospital has a non -delegable duty to provide an E.R. physician at the facility and that seeing patients at a site other than the E.R. would present a high risk. There was discussion regarding the current Medical Staff bylaw requiring rotating E.R. coverage. It was noted that this require- ment can be deleted after sufficient contracts have been signed covering the required periods. Responding to a question about malpractice insurance requirements, Joe Smith stated that RIH/CC is not financially able to bear the possibility of going "bare." If it did so, the hospital would become responsible for malpractice suits. The hospital cannot bear the cost of uninsured suits and the Borough has stated to LHS that it wants the malpractice insurance requirements to remain in ef- fect. ADMINISTRATOR'S REPORT Written report as attached. Mr. Myers stated that Joan Minks has agreed to help the Hospital with the writing of grants for home health. A Certificate of Need may need to be prepared. Mr. Smith cautioned that becoming Medicare certified for home health is difficult. Mr. Myers stated that before the facility enters into any agreement, a business plan will be developed. Mr. Myers stated that he had prepared a letter to the Lions requesting that they consider building the Solarium as a community project. Advisory Board Meeting July 25, 1991 Page Five AUDIENCE COMMENTS Alan Austerman, lobbyist for the City, stated that he felt that the State will probably not fully fund a new facility in Kodiak; that if any funding were forthcoming, it would probably not be more than 50%. Wayne Stevens asked if the preparation of a regional health care propos- al would enhance the chances of funding. Mr. Austerman indicated that he did not feel that such a proposal would necessarily be of benefit. Mr. White stated his concern that the community has not indicated that they would support building a new facility through local funding mea- sures. Mr. Myers questioned at what point does the hospital say that it won't pursue funding of a new facility. Mr. Austerman pointed out that the House only appropriated $3.8 million for all health facility funding, only 1/10th of what is needed. Ben Ardinger stated that he had noted that accounts payable for attor- ney's fees in the Eufemio matter were extremely high. He stated that his understanding was that legal costs in this matter had been set on a contingency basis. Mr. Myers indicated that he has sent this billing to Fargo for review. Lonnie White indicated that he felt that the Emergency Room contract should be reviewed because several physicians had indicated that they were willing to accept a lesser amount. Mr. Myers explained that in order for the staff to accept a lesser amount, that contractual problems would be created with Dr. Mickleson and Dr. Crane. Also he indicated that not all physicians would accept a lesser amount. Mr. Smith pointed out that the hospital's public image relied greatly on a reliable E.R. By each physician having an individual contract, the hospital will be better protected. There was a discussion about situations where patients have complaints about their bills. Mr. Myers stated that the patient can either talk to him or the Patient Advocate. There was a discussion regarding cost of medications and how services and medications are priced to support the cost of all services in the hospital, and are not simply based on cost and markup. Mr. White stated that he felt that the Board should make an effort to keep the Assembly better informed. Advisory Board Meeting July 25, 1991 Page Six Wayne Stevens thanked Joe Smith for the opportunity to accompany him to Dutch Harbor. He stated that he felt there was great potential to have a cooperative working relationship with that community. He stated that he agreed with Mr. White, that as the Advisory Board to the Borough the Board needed to be more participative with the Assembly. He suggested assigning a Board member to attend the Assembly meetings on a regular basis, as the Planning & Zoning Committee does. Mr. Stevens stated that the Southwest Alaska Municipal Association will be meeting September 5th through 8th and this would be an excellent opportunity for the Board to meet members of other communities to dis- cuss health issues. He said he felt this would be a great opportunity to sell the hospital. Mr. Smith indicated that he planned to attend. Dr. Brewer said that he felt that Mr. Myers' E.R. proposals had received attention and that action would be forthcoming. Ms. Springhill asked Mr. Myers if he meeting to discuss plans to establish basement of Holmes Johnson Clinic. 10.4 J[•� yy, • would the next P & Z Commission a detoxification center in the Moved and seconded to adjourn to Executive Session to discuss legal matters at 10:00 p.m. Motion Carried. Returned to Regular Session at 10:30 p.m. ADJOURNMENT Moved, seconded and carried to adjourn at 10:30 p.m. Recorded by Debra Raper. Jeannie Volker, Secretary/Treasurer